A mastoidectomy is performed to remove diseased mastoid air cells. These cells sit in a hollow space in the skull, behind the ear. The diseased cells are often the result of an ear infection that has spread into the skull.
Sometimes the infection spreads onto the temporal bone. If this occurs, parts of the bone may need to be removed. This results in hearing loss.
There are several types of mastoidectomy. These include:
- simple mastoidectomy: the surgeon opens the mastoid bone, removes the infected air cells, and drains the middle ear
- radical mastoidectomy: the surgeon may remove the eardrum and middle ear structures. Sometimes a skin graft is placed in the middle ear
- modified radical mastoidectomy: this is a less severe form of radical mastoidectomy. Not all middle ear bones are removed and the eardrum is rebuilt.
Some hearing loss is to be expected with radical and modified radical mastoidectomy.
This surgery is not as common as it used to be. Infections are usually treated with antibiotics, but surgery may be done if antibiotics fail.
A mastoidectomy can treat complications of chronic otitis media (COM). COM is an ongoing ear infection in the middle ear. If untreated, it can cause a cholesteatoma (skin cyst). The cyst grows gradually over time and may lead to serious complications such as:
- abscess in the brain
- vertigo (dizziness)
- damage to the facial nerve (causing facial paralysis)
- meningitis (swelling of the brain)
- labyrinthitis (inflammation of the inner ear)
- ongoing ear drainage
- spread of cyst into the brain
A mastoidectomy may also be done to put in a cochlear implant. This small, complex electronic device can help to provide a sense of sound to a person who is profoundly deaf or severely hard-of-hearing.
This surgery can also be used to remove abnormal growths at the base of the skull.
A mastoidectomy is usually performed under general anesthesia. This ensures the patient is asleep and unable to feel pain. For a simple mastoidectomy, the surgeon will usually:
- access the mastoid bone through the ear or a cut made behind the ear
- use a microscope and a small drill to open the mastoid bone
- use suction irrigation to keep the surgical area free of bone dust
- remove the infected air cells
- stitch up the operative site
- cover the site with gauze to soak up drainage
The surgeon may also use a facial nerve monitor. This ensures the facial nerve is not damaged.
When you wake up, you can expect to have bandages over your ear. There will also be stitches close to your ear. You may have a headache, discomfort, and some numbness.
After surgery, your health care provider may:
- prescribe pain medication
- use topical antibiotic drops to decrease the risk of infection
- schedule you to return for removal of your bandages and stitches
Your health care provider may also tell you to:
- cover the operative site while bathing (with a cup or a petroleum jelly-covered cotton ball)
- avoid strenuous activity
- avoid air travel
- avoid putting pressure on your ear
Complications of a mastoidectomy include:
- facial nerve paralysis or weakness (a rare complication caused by facial nerve injury)
- sensorineural hearing loss (a type of inner ear hearing loss that may occur in up to six percent of patients)
- vertigo (dizziness; it may persist for several days)
- change in taste (food may taste metallic, sour, or otherwise “off”; this often resolves after a few months)
- tinnitus (abnormal noises in the ear such as ringing, popping, and hissing)
Call your health care provider if you experience any of the above. You should also call if you have heavy ear bleeding or a fever over 100.5 degrees F.
The outlook varies depending on the reason for the mastoidectomy. The type of mastoidectomy performed also affects it. Hearing loss is common with both modified radical and radical mastoidectomy.
Patients with cholesteatoma need to have regular follow-ups with their doctor. According to Medscape, up to 50 percent of patients may have another cyst if the canal wall of the ear is not removed during the surgery. If the canal wall is removed, up to 10 percent of patients may have another cyst (Medscape, 2011).